Author:
Bronwyn
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Date Posted: 13:46:43 07/26/01 Thu
Remember Rochelle's case study Helen?
Please read again and look at my responses as well. It is worth taking a look at as very pertinent to body fluids.
Rochelle's case study
>We had an interesting case come in the other week, the
>history goes as follows:
>A women aged 63 years came in ventialted and sedated,
>she was previously well. @/52 ago she knocked her R)
>leg on the rotary hoe, then pre-admission had a 3/7 hx
>of hypertension and her GP started heron the
>antihypertensive of Indapamide. The next day she
>blacked out and 'fainted' but came right. The
>following day the neighbours noticed that things
>weren't as they usually are so they called the
>ambulance ( knowing that *Helen had blackout the day
>before), the police were called to break into the
>house. *Heln was found next to her bed with a GCS of
>6.
>CT Scan of the head was NAD.
>There was a working diagnosis of tetanus fro the R)
>leg wound , which was debrided.
>Admission labs were Na 110, K 2.7, Urea 2.4,
>Creatinine 46, Mg 0.65, Corr Calcium 2.15, Phospahte
>1.01, Glucose 7.5
>A lumbar puncture was done, CSF was clear, pressure
>was low and WCC was 1.0.
>*Helen was being managed on fluid restriction, having
>IVF of D5W + 20% NaCl with regular K additives.
>At 1400hrs the following day *Helen's GCS was 13-15
>and her labs were as follows Na 121, K 4.0, Urea 2.5,
>Creatinine 41, Mg 0.90, Corr Calcium 2.15, Phosphate
>0.66
>By this stage we had veered away fromt eh diagnosis of
>tetanus and were thinking it was more a side effect
>from the Indapamide, which can have occasional side
>effect of hypokalaemia and rare effect of a diuretic.
>I think *Helen decreased GCS was related to her low K
>and dehydration due to her large diuresis, which in
>effect lowered her Na ( she had been thirty prior to
>her initial blackout).
>What do you think?
>*Helen is a fictional name.
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